What Pharmacists Need to Know

Pharmacy team members are an integral part of vaccination efforts in the United States. According to the CDC, as of May 11, 2022, more than 248 million doses of COVID-19 vaccines have been administered in pharmacies across the United States.1 This includes more than 8 million doses that pharmacists administered at long-term care facilities in 2021 to some of the most vulnerable patients in the nation. Pharmacists, student pharmacist interns, and pharmacy technicians, however, have given substantially more immunizations than those documented by the CDC for COVID-19 vaccines. They also administer seasonal influenza (flu) vaccines and routine adult and pediatric vaccines. Even before the pandemic, pharmacy team members played a major role in immunizations. During the 2020-2021 influenza season, more than 47 million doses of flu vaccine were administered to adults in US pharmacies, compared with 32 million doses administered in physician offices.2

The third amendment of the Public Readiness and Emergency Preparedness
Act was issued in August 2020 to combat declining routine childhood immunization rates during the pandemic.3 It authorizes pharmacists in all US states to administer routine pediatric vaccines to children as young as 3 years of age. Pharmacy team members are now able to administer more types of vaccines to more patients than at any time in history. However, this also means that keeping up to date on immunization advancements, changes, and updates is more important than ever. This article provides an update on the vaccine recommendations from the Advisory Committee on Immunization Practices (ACIP) that have been made and approved for 2022.

How Are Decisions About Vaccine Recommendation Updates Made?

Each year, a new immunization schedule is recommended by the ACIP, a committee within the CDC, after in-depth consideration of vaccine-related data. The ACIP comprises 15 voting members whose medical and public health expertise includes vaccinology, immunology, pediatrics, internal medicine, nursing, family medicine, virology, public health, infectious diseases, and preventive medicine. When making recommendations about vaccines, the ACIP considers data that include epidemiology and societal impacts of diseases and effectiveness and safety of the vaccines. Historically, the ACIP meets 3 times each year to review new information and vote on vaccine recommendations, although more frequent meetings were needed during the pandemic. Recommendations made by the ACIP are reviewed and approved by the CDC, the American College of Physicians, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American College of Nurse-Midwives, the American Academy of Physician Associates, and the Society for Healthcare Epidemiology of America. Official vaccine recommendations are published in the CDC’s Morbidity and Mortality Weekly Report (MMWR).4

Anyone interested in learning the new vaccine recommendations in the United States may consider watching upcoming ACIP meetings, which are livestreamed for free to the public.5 Additionally, the CDC allows written public comments and requests to make oral public comments at upcoming meetings. Dates for upcoming meetings, agencies, registration information, and directions on submitting a public comment are available under the Meeting Information section on the ACIP website. After each meeting, the presentation slides and videos are available online.

Changes to the Recommended Adult Immunization Schedule for Ages 19 Years and Older

The recommended immunization schedule for adults aged 19 years and older is available in different formats, and pharmacy team members should be aware of the options.6 One version of the schedule is organized by age group. This version can be useful when helping a new or existing patient identify which vaccines may be needed, which can be determined simply by asking their age. Another version of the schedule is organized by medical condition or indication. This version may be useful when a patient receives a new diagnosis or has another indication that necessitates additional vaccinations.

When reading the immunization schedule, it is important to be familiar with the color coding and the meaning of each color.6 On the schedule organized by age, yellow indicates that the vaccination is recommended for adults who have not been vaccinated who meet the indicated age requirement, lack documentation of previous vaccination, or lack evidence of past infection. For example, the schedule organized by age, in the column for adults 65 years and older, the row for pneumococcal is yellow, indicating pneumococcal vaccination is recommended for that age group. Purple indicates that the vaccination is recommended for adults in an age group who have an additional risk factor or indication. When a patient meets the criteria in the purple section, the Notes section of the schedule should be checked for more details. When the schedule row is blue, shared clinical decision-making about vaccination is recommended.

In addition to the yellow, purple, and blue color coding, the adult schedule organized by medication condition or indication includes red, indicating that the vaccination is contraindicated and should not be administered, and orange, which indicates precaution that the vaccination might be indicated if the benefits of protection outweigh the risk of adverse reactions.

The ACIP approved the recommended adult immunization schedule for adults at least 19 years old at the November 2021 meeting.7 The 2022 schedule includes several updates and changes from the 2021 schedule, in addition
to an appendix listing contraindications and precautions for all vaccines in the schedule. Changes for the 2022 adult immunization schedule include revised recommendations for the hepatitis B, influenza, pneumococcal, zoster, and COVID-19 vaccines. Also, the language for recommendations regarding measles, mumps, rubella; meningococcal; and varicella vaccines was revised to improve clarity. A summary of the changes is shown in Table 1.6.7

Changes to the Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger

Similar to the adult schedule, the recommended immunization schedule for children and adolescents is available in different formats.8 The recommended child and adolescent immunization schedule for ages 18 years or younger consists of 3 tables: (1) by age group; (2) by catch-up schedule; and (3) by medical condition or indication. The catch-up schedule is useful for pediatric patients who are behind on their routine immunizations or have missed a dose.

One difference between the immunization schedule for adults and the schedule for children and adolescents is the addition of a variegated color code, yellow with brown checks.8 In the table organized by medical indication, this color code is used to indicate that vaccination is recommended and that additional doses may be needed. In the schedule organized by age, yellow with brown checks indicates that recommended vaccination can begin in a particular age group. When a pharmacy team member identifies a child or adolescent with characteristics that correspond with the yellow with brown coding checks, the Notes section should be consulted to find additional information. Table 2 shows a summary of the recommended changes to the 2022 child and adolescent immunization schedule.8.9 In addition, the definition of severe immunosuppression due to HIV infection was changed to “<15% or total CD4 cell count of <200 / mm3” for consistency with the ACIP's General Best Practice Guidelines for Immunization.

Conclusions

One of the most important things that immunizing pharmacy team members can do is stay up to date on the most recent immunization recommendations. By utilizing the recommended immunization schedules to identify those in need of vaccination, we are protecting ourselves, our patients, and providing an important public health service.

About The Author

Kimberly C. McKeirnan, PharmD, BCACP, is an associate professor in the Department of Pharmacotherapy and the director for the Center of Pharmacy Practice Research at Washington State University College of Pharmacy and Pharmaceutical Sciences in Spokane.

References

1. The federal retail pharmacy program for COVID-19 vaccination. Centers for Disease Control and Prevention. May 17, 2022. Accessed May 25, 2022. https://www.cdc.gov/vaccines/covid-19/retail-pharmacy-program/index. html

2. Influenza vaccinations administered in pharmacies and physician medical offices, adults, United States. Centers for Disease Control and Prevention. February 23, 2022. Accessed April 14, 2022. https://www.cdc.gov/flu/ fluvaxview / dashboard / vaccination-administered.html

3. Third amendment to declaration under the public readiness and emergency preparedness act for medical countermeasures against COVID-19. Federal Register. August 24, 2020. Accessed April 29, 2022. https://www.federalregister.gov/documents/2020/08/24/2020-18542/third- amendment-todeclaration-under-the-public-readiness-and-emergency – preparedness-act-for-medical

4. Role of the advisory committee on immunization practices in CDC’s vaccine recommendations. Centers for Disease Control and Prevention. January 12, 2022. Accessed April 13, 2022. https://www.cdc.gov/vaccines/ acip / committee / role-vaccine-recommendations.html

5. ACIP meeting information. Centers for Disease Control and Prevention. April 8, 2022. Accessed April 14, 2022. https://www.cdc.gov/vaccines/acip/ meetings / index.html

6. Adult immunization schedule. Centers for Disease Control and Prevention. February 17, 2022. Accessed April 10, 2022. https://www.cdc.gov/vaccines/ schedules / hcp / imz / adult.html.

7. Murthy N, Wodi AP, Bernstein H, McNally V, Cineas S, Ault K. Advisory committee on immunization practices recommended immunization schedule for adults aged 19 years or older – United States, 2022. MMWR Morb Mortal Wkly Rep. 2022; 71 (7): 229-233. doi: 10.15585 / mmwr.mm7107a1

8. Child and adolescent immunization schedule. Centers for Disease Control and Prevention. February 17, 2022. Accessed April 10, 2022. https: // www. cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html

9. Wodi AP, Murthy N, Bernstein H, McNally V, Cineas S, Ault K. Advisory committee on immunization practices recommended immunization schedule for children and adolescents aged 18 years or younger – United States, 2022. MMWR Morb Mortal Wkly Rep. 2022; 71 (7): 234-237. doi: 10.15585 / mmwr.mm7107a2

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